Efficacy and safety of medications for managing urinary incontinence in people living with cognitive impairment, dementia or in long-term care: a systematic review.

INTRODUCTION: The absence of guidance on pharmacological management of urinary incontinence (UI) for individuals with dementia may lead to potentially avoidable medication-related harm. This systematic review aimed to evaluate efficacy and safety of medications for managing UI in people living with cognitive impairment, dementia or in long-term care. METHODS: Four bibliometric databases were searched for randomized control trials (RCTs) from inception to March 2026. Risk of bias was assessed using the Joanna Briggs Institute critical appraisal tool for RCTs. Efficacy, adverse events (ADEs) and cognitive effects were synthesized. RESULTS: Nine RCTs (N = 310 participants) were included (all had possible risk of bias). Efficacy of oral anticholinergics ranged from no significant effects to up to 17% greater reduction in UI symptoms compared with placebo while oral estrogen demonstrated no significant effects compared with placebo. Dry mouth was the most common ADE in participants on oral anticholinergics (n = 61/194 participants in intervention vs 26/194 in control across 4 trials). Oral anticholinergic effects on cognition (reported in three trials) ranged from no significant effects to statistically significant short-term declines in attention/alertness compared with placebo. CONCLUSIONS: UI medications for people with cognitive impairment or dementia should be prescribed cautiously, with consideration of possible benefits and harms. PROSPERO: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251270946.